Health Care Analysis

, Volume 2, Issue 2, pp 111–117 | Cite as

The changing blueprints of the british NHS: The white papers of 1944 and 1989

  • Martin Powell
Original Paper


It has recently been pointed out that the 1989 White PaperWorking for Patients, which provides the basis for the current reforms of the British National Health Service, has some common features with the 1944 White PaperA National Health Service, which was the unadopted model for the service produced by the Wartime Coalition Government. Moreover, it is likely that the Conservatives, if elected in the 1945 General Election, would have introduced a service based on a modified version of the 1944 document. We can compare these two blueprints to shed some light on Conservative thinking on health care over a period of nearly 50 years. There are some similarities in terms of the notions of purchaser and provider, contracts and pluralism. However, there are striking contrasts, notably in their attitude towards planning versus competition and local democracy versus patronage. It is claimed that the profound differences outweigh the apparent similarities and consequently the two blueprints show the discontinuity rather than the continuity of Conservative thinking on health care.


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Copyright information

© John Wiley & Sons, Ltd 1994

Authors and Affiliations

  • Martin Powell
    • 1
  1. 1.Division of Social SciencesUniversity of Hertfordshire, Hatfield CampusHatfieldUK

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